Health Plan Weekly

Amid what the Centers for Disease Control and Prevention (CDC) is calling an “epidemic” of sexually transmitted infections (STI), the California Department of Insurance issued a mandate to a portion of health insurers operating in the state that would ban medically unnecessary limits on test screenings.

On June 1, Insurance Commissioner Ricardo Lara announced that his office would crack down on insurers that are “arbitrarily refusing to cover necessary treatments,” according to a press release. The federal Affordable Care Act (ACA) forbids health insurers from limiting STI screenings for people at elevated risk of infection and does California state law, giving Lara’s department wide latitude for enforcement.

The Supreme Court voted 6-3 to overturn the constitutional right to abortion established in Roe v. Wade. The ruling, released on Friday, will allow states to fully ban abortion without exceptions for rape, incest or the life of the mother. Experts predict that maternal mortality could increase by as much as 21% nationwide if abortion is banned nationally.

The Federal Trade Commission (FTC) ratcheted up regulatory pressure on PBMs once again, announcing that it will apply more scrutiny to PBMs' rebating practices, particularly regarding insulin. The move follows the agency's announcement earlier this month that it would investigate PBM business practices and consolidation. In an official policy statement, the agency wrote that “some have suggested that high rebates and fees to PBMs and other intermediaries may incentivize higher list prices for insulin” and that “rebate and fee agreements may incentivize PBMs and other intermediaries to steer patients to higher-cost drugs over less expensive alternatives.” Actions the agency said it would pursue include cracking down on exclusionary rebates and intensifying scrutiny of formulary design.

The Federal Trade Commission (FTC) on June 10 made a formal request for information to UnitedHealth Group regarding the integrated health care giant’s announced purchase of LHC Group, Inc., a home health care provider, which could be an indication that the antitrust watchdog will move to block the deal. Experts tell AIS Health, a division of MMIT, that it’s not a certainty that the FTC will take such an action, given the fragmented nature of the home health care industry, but add that UnitedHealth’s singular size and diversification exposes the firm to higher antitrust scrutiny than other national health insurance or provider firms.

UnitedHealth announced its plans to acquire LHC in April, saying it would spend about $6 billion to purchase the provider and amortize some of its debt. The health care giant revealed the FTC’s request for information in a filing with the Securities and Exchange Commission. UnitedHealth has acquired dozens of smaller companies in recent years — and antitrust regulators have begun to pay closer attention as its spending sp

Scrutiny of health care sharing ministries (HCSMs) is growing, with Colorado becoming the second state to require the entities to submit health care financial data to insurance regulators amid stepped-up scrutiny from state insurance regulators nationwide. Meanwhile, a Florida health system filed a lawsuit challenging the common practice among HCSMs of pushing members to conceal their sharing ministry enrollment when dealing with providers’ billing departments, which Orlando Health contends is an effort to “illegitimately secure the reduced ‘charity rate.’”

HCSM supporters contend that the religious organization-affiliated ministries provide a less expensive alternative to health insurance for members who agree to comply with faith-based lifestyle restrictions and pledge to “share” medical costs among members. But critics say the programs provide no guarantees of coverage and are exempt from much insurance oversight, while still being marketed in many cases by brokers with terminology such as provider networks and benefit design names that mimic traditional insurance.